A nurse is reinforcing teaching about elimination with an adolescent who is paralyzed from the waist down following a spinal cord injury.
Which statement by the adolescent indicates a need for further teaching?
I do my wheelchair exercises sitting in my chair.
I use a suppository every night to have a bowel movement.
I need to catheterize myself twice a day.
I carry a water bottle with me because I drink a lot of water.
The Correct Answer is C
Choice A rationale:
The statement “I do my wheelchair exercises sitting in my chair” is correct. Wheelchair exercises are designed to be performed while seated in a wheelchair. They help to maintain muscle strength and flexibility, which is crucial for individuals with paralysis.
Choice B rationale:
The statement “I use a suppository every night to have a bowel movement” is also correct. Individuals with paralysis often have difficulty with bowel movements due to lack of muscle control. Using a suppository can stimulate the rectum and induce a bowel movement. Choice C rationale:
The statement “I need to catheterize myself twice a day” indicates a need for further teaching. Individuals with paralysis from the waist down following a spinal cord injury typically need to perform intermittent self-catheterization every 4-6 hours, not just twice a day. This helps to prevent urinary tract infections and bladder overdistension.
Choice D rationale:
The statement “I carry a water bottle with me because I drink a lot of water” is correct. Drinking plenty of water is important for overall health and can help to prevent urinary tract infections, which are common in individuals who self-catheterize.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is: B. Decreased deep tendon reflexes.
Choice A rationale: Wheezing is not typically associated with hyperkalemia. It is more commonly related to respiratory conditions.
Choice B rationale: Hyperkalemia can cause decreased deep tendon reflexes due to the effect of high potassium levels on nerve conduction and muscle function.
Choice C rationale: Hypoactive bowel sounds are not a common sign of hyperkalemia. They are more often associated with gastrointestinal issues.
Choice D rationale: Cerebral edema is not related to hyperkalemia. It is usually associated with conditions affecting the brain, such as trauma or infections.
Correct Answer is A
Explanation
Choice A rationale:
Caffeinated beverages are known to cause diarrhea. Caffeine naturally occurs in many foods and drinks, including coffee and chocolate. It speeds up the digestive system and can cause loose stools. In addition, caffeine can irritate the stomach lining during digestion. Therefore, it’s important for the nurse to educate the patient about the potential effects of caffeinated beverages on their digestive system.
Choice B rationale:
Low-fiber cereal is not typically associated with triggering diarrhea. In fact, foods that are low in fiber can actually help firm up stools and are often recommended for individuals experiencing diarrhea. Therefore, while it’s not harmful, it’s not a primary concern for patients with diarrhea.
Choice C rationale:
White rice is another food that does not typically cause diarrhea. Similar to low-fiber cereal, white rice can help firm up stools and is often recommended for individuals experiencing diarrhea. It’s not a primary concern for patients with diarrhea.
Choice D rationale:
Ripe bananas do not typically cause diarrhea. They are actually part of the BRAT diet (Bananas, Rice, Applesauce, Toast), which is often recommended for individuals experiencing diarrhea. Therefore, it’s not a primary concern for patients with diarrhea.
In conclusion, when educating a patient about food and drinks that can trigger diarrhea, the nurse should include caffeinated beverages as they can potentially cause diarrhea. However, low-fiber cereal, white rice, and ripe bananas are not typically associated with triggering diarrhea.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.